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Erodotou et al. Mini-invasive Surg 2023;7:35 https://dx.doi.org/10.20517/2574-1225.2023.95 Page 7 of 12

40 cases for increased lymph
node yield
80 cases for decreased
anastomotic leakage rates and
vocal cord palsy
Zhang 2018 China Retrospective 72 Da Vinci Open, MIE, and single McKeown; Robotic NR NR CUSUM 26 cases for decreased total
[25]
et al. Si benign robotic case thoracic and operation time
abdominal phase
9 cases for decreased thoracic
port set-up and docking time
14 cases for decreased
abdominal operation time
16 cases for decreased
abdominal port set-up and
docking time
32 cases for increased lymph
node yield
Zhang 2018 China Retrospective 249 Da Vinci NR McKeown; Robotic NR NR Comparison between 25 cases for decreased
et al. [34] thoracic and cohorts of 25 thoracic operating time
abdominal phase procedures for the 50 cases for increased lymph
first 100 cases
node yield and shorter hospital
stay
Zhuo et al. [35] 2021 China Retrospective 100 NR MIE McKeown or Ivor NR NR CUSUM 18 cases for increased thoracic
Lewis; robotic lymph node yield using the
thoracic and McKeown approach
abdominal phases
MIE: Minimally invasive esophagectomy; VATE: video-assisted thoracoscopic esophagectomy; VAME: video-assisted McKeown esophagectomy; CUSUM: cumulative sum control chart; RA-CUSUM: risk-adjusted
cumulative sum control chart; RAMIE: robotic-assisted minimally invasive esophagectomy; NR: not reported.

phase 3 and performed RAMIE independently . Our study compared the results of the newly introduced surgeon with an experienced proctor (> 150 RAMIE
[21]
procedures). Initially, the new surgeon performed 15 RAMIE procedures on selected patients with fewer pulmonary and oncologic diseases under firm
supervision by the proctor. This resulted in decreased thoracoscopic and total operating times .
[23]

Learning curve
The definition of the learning curve is the number of operations that must be performed to achieve a steady level of performance, known as the plateau. The
cumulative sum control chart (CUSUM) was the most commonly used method for evaluation of the learning curves. CUSUM analysis transforms raw data
[23]
into the running total of data deviations from the group mean, enabling investigators to visualize the data for trends not discernible with other approaches .
The most commonly used measured variables were the total operation time, robot thoracic and abdominal console time, lymph node yield, vocal cord palsy
rates, blood loss, anastomotic leakage rates, length of the hospital stay, and conversion rates to an open procedure. A wide variation was noted in the learning